Genetics & Clinical Cohorts

为了到2035年将结核病死亡人数减少95%，世卫组织结束结核病战略指出，关键是引入 需要新的工具，如疫苗、药物和治疗制度，以及护理点检测。新工具可用于 消除结核病有赖于对结核病的新知识。在这里，我们利用基因组技术来询问 结核病原体和宿主基因组变异促进我们对结核病的基本认识 推动设计新疫苗和药物以控制结核病流行所需的创新。 我们将利用我们来自越南和乌干达的广泛的临床、流行病学和基因队列 在过去的20年里，为了发现结核病的基因决定因素，进展和 人类和结核分枝杆菌的结局。我们的目标是识别活动性肺结核的遗传决定因素 人类的疾病和结核分枝杆菌，2/确定人类的遗传决定因素和与细菌相关的结核分枝杆菌 负担和糟糕的疾病结局3/确定与传播有关的细菌变异，使用 传播的进化和流行病学特征。在目标1和目标2中，我们将使用配对的主机和 来自大量肺结核患者的病原体基因组数据集，并分析宿主和病原体 单独的和组合的基因组数据。在这些目标中，我们将研究寄主和病原体基因 与结核病和临床终点以及“中间表型”相关的变异，如 宿主控制细菌的复制、细菌在宿主内的存活和细菌的清除。在《目标3》中，我们将使用 细菌基因组序列用于鉴定导致疾病传播性的结核分枝杆菌基因变异1/ 利用低发户和低发病者的流行病学数据询问进化和2/2的基因组信号 结核病高传播率。CORE A Genetics的目标是将基因发现交付给Functional 分析，而在3个项目中使用体外和体内模型确定的功能候选将是 在我们的临床队列中进行评估，以弥合结核病模型和人类之间的“研究”差距 结核病。通过人类和细菌基因组学，核心A的结果将是鉴定的关键 结核分枝杆菌感染的反应机制、结核分枝杆菌的传播性、结核病易感性和疾病结局。这 研究将通过促进我们对结核病的基本理解而产生影响，结核病是驾驶汽车必不可少的 未来结核病疫情控制的创新。

To achieve a 95% reduction of TB deaths by 2035 the WHO END-TB strategy states that critical introduction of new tools, such as a vaccine, drugs and treatment regimes, and a point-of-care test are required. New tools to eliminate TB are reliant on new knowledge of TB. Here we are utilizing genomic technology to interrogate pathogen and host genomic variation in TB to advance our fundamental understanding of TB which is critically required to drive innovation for the design of new vaccines and drugs to control the TB epidemic. We will utilize our extensive clinical, epidemiological and genetic cohorts from Vietnam and Uganda which have been complied over the last 2 decades, to discover genetic determinants of TB disease, progression and outcome in humans and M.tuberculosis. We aim to 1/ identify genetic determinants of active pulmonary TB disease in humans and M.tb, 2/ identify genetic determinants in humans and M.tb associated with bacterial burden and poor disease outcome 3/ identify bacterial variants associated with transmission, using evolutionary and epidemiological signatures of transmission. In aims 1 and 2 we will utilize a paired host and pathogen genomic dataset from a large cohort of pulmonary TB patients, and analyze both host and pathogen genomic data individually and in combination. In these aims we will investigate host and pathogen gene variants associated with TB disease and clinical endpoints, as well as with “intermediate phenotypes” such as host control of bacterial replication, bacterial survival in the host, and bacterial clearance. In aim 3 we will use bacterial genome sequence to identify Mtb gene variants contributing to disease transmissibility by 1/ interrogating genomic signals of evolution and 2/ by utilizing epidemiological data of households with low and high TB transmission. The aims of core A Genetics will deliver gene discoveries to the 3 projects for functional analysis, while functional candidates identified in the 3 projects using in vitro and in vivo models will be assessed within our clinical cohorts to bridge the “investigative” gap between TB disease models and human TB disease. Through human and bacterial genomics, the outcome of core A will be the identification of key mechanisms in the response to Mtb infection, Mtb transmissibility, TB susceptibility and disease outcome. This research will have impact by advancing our fundamental understanding of TB which is essential to drive innovation for the future control of the TB epidemic.